Healthcare Provider Details

I. General information

NPI: 1033378963
Provider Name (Legal Business Name): KEVIN D KEITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 N PATTERSON ST
VALDOSTA GA
31602-2512
US

IV. Provider business mailing address

2417 N PATTERSON ST
VALDOSTA GA
31602-2512
US

V. Phone/Fax

Practice location:
  • Phone: 229-433-1861
  • Fax:
Mailing address:
  • Phone: 229-433-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number66959
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberOS016409
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: